The Iron Triangle: Quality, Access, Costs.

 

The Tower of Babel was to create a path to heaven and establish their destiny. What then?

The Iron Triangle, can be seen as an unforgiving force, you can’t have one without losing in another. Value Based care, has yet to demonstrate a clear path. Population specific strategies have improved quality, but not with net savings. Care management for specific conditions has saved costs but not without biased access. 

Some advocates of Advance Payment Models admit these models are underperforming and that results at best are mixed. Yet these same advocates promote the importance for Medicare to lead in a series of ‘(dis-)incentives’ to eliminate voluntary participation. Though value based care has “not yet” improved access to care OR outcomes, CMS is encouraged to develop a system to eliminate voluntary participation.

Unfortunately, “portfolio-based” approaches, as some suggest, require data: expected values; expected distributions; and an understanding of the counterfactuals - yet a system without direction, is a race car with no race. 

My Recommendations:

• Increase access, by granting full practice to Advance Practice Nurses.
• Improve costs, with specific incentive initiatives
• Improve quality, by keeping things voluntary

Otherwise, the Tower will be built and we will face an unforgiving force.